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Home My WebLink AboutRLC94-0956 - RLC Application - 4/27/1994 32-1 2-7 —5Lf doo &,5 Date Received: -c2 -q 4 MASON COUNTY DEPARTMENT OF COMMUNITY-DEVELOPMENT RESOURCE LANDS AND CRITICAL AREAS CHECKLIST The fol%wing checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System 5 Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, La Segregations, Hazardous Waste Permit or Shoreline Permit in determining whether their property is affected regulations under the Mason 9 County Interim to im Resource Ordinance (77-93) . This checklist is an import opportunity for identifying early in the permit process whether there willbe any environmental regulations affect, the proposed development. Owner LvR ,4,(../351) y L Phone #(oz aQ 7,5,P P Site Address efi 6.S- D. v S_(_DLDE �K/►s[f/�nanl ,( �Kr� �� ,,, C.R��K City_S ffi=crv.� Zip �fgs8�f Owner Address G ,4s City_ SFfC4ra n, State w�Zipgp,!r P /� Tax Parcel No. (Confirm with Assessors Office)-o � Q I v. T 4.14 Kt'a L wf:r12 i &k Legal Descripti,on_ Project Description_�L►3e c .�,F w n�o/a�} /�-PPR v yr-n S.pl�7-, � Gr�2r+Gr; Directions to site (Please attach map) Please provide or attach a vicinity map which includes cross streets, major roads, creeks tc. Al m � o � o t a �brc r1hV 'l/D 0 STA ie .�*rL t�Tv y 3 Answer the following to the best of your knowledge. County,-wide maps showing general locations of critical ar( official and resource lands are available for review at Mason County Department of Community Development, Planning u.e only Department. Do any of the following exist on this property or within 200 feet of this property? LoAfty Yes No 1. Saltwater shoreline or a lake 20 acres or larger? ❑ ® 2. Rivers, streams, or creeks with year-round flow? ❑ 3. Rivers, streams or creeks with intermittent flow but are within a cl rly defined channel? ❑ ® 4. Lakes or ponds less than 20 acres in size? [ ' ❑ (� 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstanc / support vegetation adapted for,life in such conditions; such as marshes, bogs, and swamps. (See Cour Maps for guidance.) ❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps guidance.) q _ 0 o � ❑� ❑ ❑ 7. Floodplains? (See County Federal Emergency Management Maps and County Seismic Hazard N / for guidance.) 0 ❑ ❑ 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seisr Hazard Map for guidance.) / Vll You may be provided nuisance protections by the County for certain resource activities. If you are enrolled In a of the following programs: County Yes No [�' ❑ ❑ 1. Agricultural Open Space Taxation Program, RCW 84.33 [� ❑ ❑ 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest, / RCW 84.34 " Copies are available at Mason County Department of Community Development for t5.00 each. I�L_vV VIIVG LHIIAUJ CX 1i111 1 IV/-1L 1AMCA0 SITE PLAN PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE: P. Location &dimensions of existing & proposed property boundaries. P. Approximate slope of land (grade &direction),topography. /"LI• Sr ► Identify legal access Including,width of all road right-of-ways&easements. ► Location of significant natural features(water bodles, rivers). 7Co , ► Locate all existing &proposed structures,dralnflelds, wells &driveways. ► Project description 1-4XrE Scale 1"= ,s o, North Arrow /0 0 �v } e c �g4 AO vh V PjeIVr w'y ©�D C N -wa as C'o n. ry f)CWS,CATIFD 081) I state that I have answered the above truthfully to the best of my knowledge. Applicant/Owner Da FOR OFFICIAL USE ONLY Adjacent property. �:•R�?i:!:.�;�;i:�'(:�F;:;:�:�::;rig;:;:n:!<:!GiS' :�:�S�$"":�'�::i;:?:ti:4iiY�Y'.:�:;:;:?::<':jh:i;i:i:�'L�i:i�i:ti�:::;:ii::�i:�i:�i:Jf�:'i:i::<i:�i:::�,:�:�: :::�:;ri;':�'. L ,y;:..,•., .,.....:.;;..:' :"'?:;:5.;::.'::rkr:::>S;:ii;;:::r?•<y:L::�'�i i:;i i:;'icy i' ::;.::::.::...:.:.::>:: .;:::;}n:.•:;•::^•;:;::r•<n: i:u'R :i: i�:C".•: � >> i sign'�`'r'�:�C�:S :�%:i:::�:::ji::��::�::�:�:�:'��:�?:`::�':::;;: n r ;:... :'.:::..;;:.:;::>:,�s.rY .'Crq.41....� ...R:�S.p.!�l..a.0..�e cf . � na s ::.><.:::.::.;•:«:<.;::.::.;:.;:::.::::::.::;...:.:::<;.::.;:;•.:::<:: :.. .............................................:..:.::.::::::::::::::.::.:p::.{.:............ .....a..... ................... ......:.:.::.:: ....:...:................................................... ::` ... >1`` ` re• .......... ::...:.. ...Ndffi Shareii'ne .....:.:..: .:............1 a>`::;: :> : > <: < .11hrner [..Resocir !~aid::::;:.:>::>:>::::: ..:.. .. .:.... .::.:.:.... X. There Is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mase County Treasurer. When completed, this form becomes part of the permit application.